Violet | Discussing social determinants of health with a patient. (2024)

Guide

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Proactive screening of social determinants of health can help clinicians to better understand their patients, build mutual trust, and identify areas of opportunity to support patient well-being. Discussions of social determinants of health can help to identify barriers to access and adherence to care and may help patients to feel supported and understood.

When starting the conversation about social determinants of health:

Don’t rely on the patient to start the conversation.

• Patients understandably may experience discomfort or hesitance in disclosing information about the context of their identities, lives, and experiences.
• It is important to be sensitive to these concerns and recognize the importance of building trust and rapport.

Don’t make assumptions or generalizations, and proactively ask questions.

• Knowledge about groups who, on average, face greater demands of social determinants of health is helpful, but should not be used to make assumptions about individuals’ life contexts.
• For example, assuming a patient's insurance will not cover a treatment option or that they will have difficulties understanding and following recommendations may negatively influence your care for and relationship with that patient.

Don’t make demands, but instead set expectations and offer permission.

• Respecting a patients’ right to decide the information they disclose is crucial to building and maintaining trust and rapport.
• Instead of directly questioning a patient, consider starting by clarifying that it is appropriate and welcomed to discuss issues related to social determinants of health.
• For example, instead of asking “What is your housing situation?” you might say “I’m happy to talk about all kinds of things including your living situation, community, and financial situation if you’d like to share. These conversations might help me to understand and care for you better.”

If patients don’t bring up social determinants of health...

• Open-ended questions can be a respectful and supportive starting point to build trust and learn more.
• For example, when providing instructions for use of a medication, we might ask “Do you understand?” and receive either a yes or no answer. This yes or no is often the end of the conversation.
• Instead, asking questions such as “What are some things that may get in the way of us being able to follow this plan?” or “What are some ways in which you might find some help or support in following this plan?” may help to start the conversation about social determinants of health and pave the way for more specific questions (e.g., “Would you like to discuss resources that may help with ___?”) depending on the patient's preferences.

When screening for social determinants of health using a questionnaire or survey:

Explain the questionnaire or survey to the patient.

• Confirm they understand what you are asking and why you are asking it.
• For example, “This is a survey of information about your life, identities, and experiences. We’re interested in this information because much of it is related to your health, and can help us to understand you and care for you better.”

Don’t demand responses; respect patients’ agency in disclosing information.

• Ensure the patient knows that they are free to disclose only what they choose to and communicate respect for their agency in responding.
• For example, “We appreciate you answering any and all questions you are comfortable sharing about, but please feel free to leave questions blank.”

Don’t make assumptions based on survey responses.

• Behind every response on a questionnaire is a story to be heard.
• Patients who respond identically on surveys and questionnaires may still have significantly different lives and experiences.

Make space to discuss results.

• Offering time to discuss a patient’s responses communicates care and attention, and can provide opportunities for patients to clarify and elaborate on their responses.

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Patients are entitled to agency and respect in the decision to share information about their lives, identities, and experiences. Maintaining a posture of openness and providing space for patients to share without demand or expectation may help to build bridges of trust.

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All clinicians experience “blind spots” about their patients’ lives, identities, and experiences. Even when we think we understand our patients, it’s important to be humble and avoid assumptions. A focus on active listening, reflection, and requests for clarification can help clinicians and patients stay on the same page.